Claims Investigator

6 months ago

Polokwane, South Africa Momentum Insure Company Limited Full time

**Introduction**Role Purpose**
- To contribute to the organisational goals by investigating, negotiating and administering claims. Identify and prevent fraudulent claims and manage expenditure on settled claims.**Requirements**:

- Matric
- Minimum 3 years investigative experience in a short-term personal claims environment
- Completion of an investigations programme would be beneficial
- FAIS accreditation or a FAIS recognised qualification will be highly beneficial

**Duties & Responsibilities**
- Receive personal line claims identified by the fraud prediction model for validation
- Confirm merits of each claim through comprehensive assessment of the item and incident
- Compile a comprehensive report on all findings and make a recommendation on a claim based on merits/evidence found during the validation process
- Refer all recommendations not within your mandate to the line manager for approval
- Irrespective of the outcome of the claim the broker, client and claims advisor to be notified (rejected claims to be communicated verbally and in writing)
- The key focus of a claims investigator is to limit financial losses due to a policy/claim fraud and to finalise and adjust claims accurately
- Obtain all evidence in a proper manner to ensure that it is admissible as evidence in a court of law
- Act as complainant where fraud is found and render all assistance and evidence to ensure the prosecution of the person who committed/attempted to commit fraud
- Report on any risks identified and suggested controls and report any other failures which influences the merits of an investigation.

**Internal Process**
- Enhance service delivery in the claims departments
- Contribute to optimising work practices and procedures via suggesting
- Up skill/influence claims advisors by sharing knowledge
- Effectively build, maintain and manage relationships with clients, brokers, service providers and business partners
- Ensure investigations are done in a professional manner and all parties are updated regularly on the progress
- Achieve minimum standards with regards to saving ratios, turnaround time, Customer Satisfaction scores, Ombudsman overturned ratios and expense ratios

**People**:

- Interact with colleagues and supply manager investigation result
- Interact with other business units i.e. claims, client services, brokers, compliance, legal etc
- Build relation/interact with support services to ensure efficiency
- Interact with clients, brokers and service providers

**Competencies**

**Competencies required
- Analytical Thinking
- Information Seeking
- Attention to detail.
- Results orientated.
- Proactive
- Agile way of thinking
- Client centric

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